- Tightness with sweating, nausea or a feeling of dread
- Pain or pressure spreading to the arm, jaw, neck or back
- Tightness that came on at rest and has lasted more than a few minutes
- Tightness with breathlessness or a fast, irregular heartbeat
- You have diabetes or known heart disease and this is new
Treat chest tightness as a heart problem until a doctor has said otherwise. Go to the nearest emergency department.
Go to the nearest emergency department, or call 8563816000
Chest tightness is one of the few symptoms where the safest first assumption is the serious one. It can come from the airways, and frequently does — but it can also be the heart, and the two are genuinely difficult to separate from the sensation alone. This page explains how they are told apart. It is not a substitute for being seen when it is happening.
Heart or lungs?
Some patterns lean one way or the other. None of them is reliable enough to bet on.
More suggestive of the heart: brought on by exertion and relieved by rest within minutes; a pressure or heaviness rather than a whistle; spreading to the arm, jaw or back; with sweating or nausea; in someone with diabetes, high blood pressure, high cholesterol or a family history.
More suggestive of the airways: comes with wheeze or cough; worse at night or in cold air, dust or smoke; relieved by a reliever inhaler; in someone with known asthma or allergy; fluctuating over hours rather than minutes.
If you are in any doubt — and particularly the first time it happens — be assessed urgently. An ECG takes minutes and settles a great deal.
Causes in the airways
Asthma. Chest tightness is one of asthma's four core symptoms, alongside wheeze, cough and breathlessness, and in some people it is the dominant one. It is often worse at night and after exercise. Asthma is confirmed with spirometry.
COPD. Tightness with exertion on a background of chronic cough and progressive breathlessness.
Chest infection. Pneumonia and bronchitis cause tightness and discomfort while active.
Pleurisy. Inflammation of the lining of the lung gives a sharp pain that is clearly worse when breathing in deeply or coughing, usually on one side.
A clot on the lung. Sudden tightness with breathlessness, sometimes coughing blood, often with calf pain or swelling in one leg. An emergency.
Acid reflux. A very common cause of chest tightness and burning, especially after meals or lying down, and often mistaken for the heart.
Muscle and rib pain. Tenderness you can reproduce by pressing on the spot, often after coughing, lifting or unusual exertion.
Anxiety and panic. Real, physical and often severe, with tingling in the hands and around the mouth. It is a diagnosis to make once the others have been considered, never a first assumption.
What is tested
- An ECG, and usually blood tests for the heart, where a cardiac cause is possible.
- Oxygen saturation and a chest X-ray.
- Spirometry with reversibility, which identifies and quantifies airway narrowing.
- Allergy testing where the tightness follows exposures.
- An echocardiogram or stress test where the pattern is exertional.
- A CT pulmonary angiogram where a clot is suspected.
Being assessed while the symptom is present is far more informative than describing it afterwards. If it comes and goes, note the time, what you were doing, how long it lasted and what relieved it — that record is genuinely useful at the consultation.
Living with it once the cause is known
Where the cause is asthma, the tightness disappears when the inflammation is controlled — which means a daily preventer, correct inhaler technique and knowing your triggers, not reaching for a reliever several times a week. Where it is reflux, dietary timing and treatment settle it. Where it is the heart, it belongs with a cardiologist, and a pulmonologist's job is to recognise that and say so.
Frequently asked questions
How do I know whether it is my heart or my lungs?
Often you cannot, from the sensation alone, and neither can a doctor without tests. An ECG and an examination take very little time. Treat new chest tightness as cardiac until that has been done.
It goes away with my inhaler. Does that confirm asthma?
It supports it, but relief can be coincidental, since many episodes settle on their own in the same few minutes. Spirometry before and after a bronchodilator is the objective test.
Can anxiety cause genuine chest tightness?
Yes — the symptom is physically real, not imagined. But it is a conclusion to reach after the heart and the airways have been assessed, because the two can occur in the same person.
I get tightness only when I exert myself. Which doctor?
That pattern leans cardiac, so start with an urgent cardiac assessment. Exertional asthma produces the same pattern, so if the heart is clear, breathing tests come next.
Should I take aspirin if my chest feels tight?
Do not self-medicate. Call for emergency help and let the clinician decide — aspirin is right in some causes and harmful in others.